Carbamazepine
| PATIENT INFO |
| Patient Name: |
| Medical Record #: |
| BD: / / Sex: F M |
| PHYSICIAN INFO |
| Physician Name : |
| Address: |
| Ph: ( ) - Fax: ( ) - |
| Additional Report to: |
| Ph: ( ) - Fax: ( ) - |
| TESTS REQUESTED | |
| Test Name: | ICD9 Code: (required) |
| 1. Carbamazepine | |
| 2. | |
| 3. | |
| 4. | |
| 5. | |
| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
CRBAM
Test Workstation :
ACHM5
Specimen Type:
Blood
Tube Type:
Green top (lithium heparin) tube
Minimum Volume:
500 uL
Preferred Volume:
1.5 mL
Storage:
Shipping- Send Refrigerated; Storage-Room Temp: 2 days; Refrigerated: 7 days; Frozen: 4 weeks
Availability:
24 hours/day, 7 days/week
Methodology:
Roche-KIMS
Special Instructions:
For therapeutic monitoring, draw peak levels approximately 12 hours postoral ingestion and trough levels immediately prior to next dose. Consistently use same time interval for peak and trough levels and dose administration for proper serial monitoring.
Lab/Phone:
330-543-8418
TAT:
1 hour
Additional Info:
Therapeutic range: 4-12 ug/mL
CPT Code:
80156
Synonyms:
Tegretol; Epitrol
